Children's Health Insurance Program Reauthorization Act (CHIPRA)

The Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 was signed into law by President Obama in January 2009. Since that time, the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS) have been working together to implement selected provisions of the legislation related to children's health care quality.

Title IV of CHIPRA promises a new day for children's health care quality, especially for those 45 million children covered by Medicaid and CHIP programs. We are pleased to share the latest information about how our work is progressing and to provide key stakeholders an opportunity to share their views on this critical endeavor.

Overview

The Agency for Healthcare Research and Quality (AHRQ) is working in collaboration with CMS, the CHIPRA Federal Quality Workgroup, and external experts to fulfill a number of requirements under Title IV of CHIPRA:

Identify an initial core set of children's health care quality measures for voluntary use by Medicaid and CHIP programs (select for a list of final, posted measures and archived materials).

Implement the CHIPRA Pediatric Quality Measures Program using grants and contracts. The PQMP will contribute to the CHIPRA-required identification of improved core children's health care quality measures for use by Medicaid and CHIP and other public and private programs, providers, plans, and patients.

As a followup to identifying the initial core measure set of children's health care quality measures, CHIPRA required establishment of a Pediatric Quality Measures Program (PQMP). CHIPRA Charge for the PQMP:

Select for the candidate measure submission form (CPCF) used by COEs to submit measures and by the Subcommittee on Quality Measures for Children's Healthcare (SNAC) to assess submitted measures. The CPCF was approved by OMB in December 2012. Select for the Federal Register announcement for public nomination of measures.

National Evaluation of the CHIPRA Quality Demonstration Grant Program

In February 2010, CMS awarded grants to 10 States to identify effective, replicable strategies to enhance quality of care and improve care delivery for children enrolled in Medicaid and CHIP. Through partnerships and collaboration, 18 States are implementing 51 projects in five general categories: the use of quality measures, health information technology applications, provider-based delivery models, use of a model format for pediatric electronic health records, and other innovative approaches to improve quality.

Children's EHR Format

The Children's EHR Format was authorized by the 2009 Children's Health Insurance Program Reauthorization Act (CHIPRA) and developed by AHRQ in close collaboration with CMS. The Format was developed to bridge the gap between the functionality present in most EHRs currently available and the functionality that would more optimally support the care of children. Specifically, the Format provides information to EHR system developers and others about critical functionality, data elements, and other requirements that need to be present in an EHR system to address health care needs specific to children, especially those enrolled in Medicaid or the Children's Health Insurance Program (CHIP).

Identification of the Initial Core Set of Children's Health Care Quality Measures

CHIPRA required that an initial core set of children's health care quality measures for voluntary use by Medicaid and CHIP programs be posted for public comment by January 1, 2010. The legislation required that the measure set:

Be drawn from measures already in use to measure children's health care quality.

Cover:

A full array of health care quality domains.

A broad array of health care services affecting children.

Children of all ages, all children's health care settings and providers.

The legislation called for the measures, when taken together, to be appropriate for use to estimate the overall national quality of health care for children.

AHRQ organized a publicly transparent, evidence-informed process to identify the initial core set of measures for consideration by CMS and the Secretary of HHS. The SNAC submitted a report to AHRQ. The measure set was posted for public comment by the legislative deadline. In February 2011, CMS posted technical specifications for the measures to be used by State programs.

At AHRQ's request, SNAC Co-Chair Rita Mangione-Smith prepared a thoughtful overview and evaluation of the Subcommittee's work in identifying the initial core set of quality measures, including a number of "lessons learned" along the way that could benefit similar future endeavors.

Additional reports, meeting transcripts, and other documents pertaining to the SNAC and the process of identifying the initial core set of measures are available. (Select Archived Materials.)